How to improve adherence to antidepressant treatments in patients with major depression: a psychoeducational consensus checklist

Bernardo Dell'Osso^{1

2

3

4}, Umberto Albert^{5

6}, Giuseppe Carrà⁷, Maurizio Pompili⁸, Maria Giulia Nanni⁹, Massimo Pasquini¹⁰, Nicola Poloni¹¹, Andrea Raballo^{12

13}, Fabio Sambataro^{14

15}, Gianluca Serafini^{9

16

17}, Caterina Viganò^{1

2}, Koen Demyttenaere^{18

19}, Roger S McIntyre^{20

21

22

23

24}, Andrea Fiorillo²⁵

Affiliations

¹ Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
² Department of Mental Health, ASST Fatebenefratelli-Sacco, Milan, Italy.
³ Aldo Ravelli' Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan Medical School, Milan, Italy.
⁴ Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA.
⁵ Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
⁶ Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Clinica Psichiatrica, Trieste, Italy.
⁷ Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.
⁸ Dept. of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
⁹ Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.
¹⁰ Department of Human Neurosciences-Faculty of Medicine and Dentistry-SAPIENZA University of Rome, Rome, Italy.
¹¹ Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy.
¹² Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy.
¹³ Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy.
¹⁴ Section of Psychiatry, Department of Neuroscience, University of Padova, Padua, Italy.
¹⁵ Padua Neuroscience Center, University of Padova, Padua, Italy.
¹⁶ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
¹⁷ IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
¹⁸ Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium.
¹⁹ Campus Gasthuisberg, Universitair Psychiatrisch Centrum KU Leuven (UPC-KUL), Leuven, Belgium.
²⁰ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON Canada.
²¹ Institute of Medical Science, University of Toronto, Toronto, ON Canada.
²² Department of Pharmacology, University of Toronto, Toronto, ON Canada.
²³ Department of Psychiatry, University of Toronto, Toronto, ON Canada.
²⁴ Brain and Cognition Discovery Foundation, Toronto, ON Canada.
²⁵ Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.

PMID: 33062034
PMCID: PMC7552507
DOI: 10.1186/s12991-020-00306-2

Review

How to improve adherence to antidepressant treatments in patients with major depression: a psychoeducational consensus checklist

Bernardo Dell'Osso et al. Ann Gen Psychiatry. 2020.

. 2020 Oct 12:19:61.

doi: 10.1186/s12991-020-00306-2. eCollection 2020.

Authors

Affiliations

¹ Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
² Department of Mental Health, ASST Fatebenefratelli-Sacco, Milan, Italy.
³ Aldo Ravelli' Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan Medical School, Milan, Italy.
⁴ Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA.
⁵ Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
⁶ Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Clinica Psichiatrica, Trieste, Italy.
⁷ Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.
⁸ Dept. of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
⁹ Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.
¹⁰ Department of Human Neurosciences-Faculty of Medicine and Dentistry-SAPIENZA University of Rome, Rome, Italy.
¹¹ Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy.
¹² Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy.
¹³ Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy.
¹⁴ Section of Psychiatry, Department of Neuroscience, University of Padova, Padua, Italy.
¹⁵ Padua Neuroscience Center, University of Padova, Padua, Italy.
¹⁶ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
¹⁷ IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
¹⁸ Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium.
¹⁹ Campus Gasthuisberg, Universitair Psychiatrisch Centrum KU Leuven (UPC-KUL), Leuven, Belgium.
²⁰ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON Canada.
²¹ Institute of Medical Science, University of Toronto, Toronto, ON Canada.
²² Department of Pharmacology, University of Toronto, Toronto, ON Canada.
²³ Department of Psychiatry, University of Toronto, Toronto, ON Canada.
²⁴ Brain and Cognition Discovery Foundation, Toronto, ON Canada.
²⁵ Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.

PMID: 33062034
PMCID: PMC7552507
DOI: 10.1186/s12991-020-00306-2

Abstract

Studies conducted in primary care as well as in psychiatric settings show that more than half of patients suffering from major depressive disorder (MDD) have poor adherence to antidepressants. Patients prematurely discontinue antidepressant therapy for various reasons, including patient-related (e.g., misperceptions about antidepressants, side-effects, and lack of tolerability), clinician-related (e.g., insufficient instruction received by clinicians about the medication, lack of shared decision-making, and follow-up care), as well as structural factors (e.g., access, cost, and stigma). The high rate of poor adherence to antidepressant treatments provides the impetus for identifying factors that are contributing to noncompliance in an individual patient, to implement a careful education about this phenomenon. As adherence to antidepressants is one of the major unmet needs in MDD treatment, being associated with negative outcomes, we sought to identify a series of priorities to be discussed with persons with MDD with the larger aim to improve treatment adherence. To do so, we analyzed a series of epidemiological findings and clinical reasons for this phenomenon, and then proceeded to define through a multi-step consensus a set of recommendations to be provided by psychiatrists and other practitioners at the time of the first (prescription) visit with patients. Herein, we report the results of this initiative.

Keywords: Adherence; Antidepressants; Concordance; Consensus; Major depressive disorder.

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Conflict of interest statement

Competing interestsIn the last three years, Dr Dell’Osso has received lecture honoraria from Angelini, Lundbeck, Janssen, Pfizer, Neuraxpharm, Arcapharma, and Livanova; Dr Serafini received lecture honoraria from Neuraxpharm, Janssen-Cilag, Angelini, and Lundbeck; Dr Viganò has received lecture honoraria from Angelini, Lundbeck/Otsuka, and Gilead. In the last 3 years, Dr. Pompili has received lectures or advisory board honoraria or engaged in clinical trial activities with Angelini, Lundbeck, Janssen, Otsuka, Italfarmaco and Allergan, which are unrelated to this article. Other authors have none to declare.

Figures

**Fig. 1**
Pro-Antidepressant Adherence Checklist (PAAC). Checklist of items to be presented at the final part of the first visit with patients with major depressive disorder (MDD) and current major depressive episode (MDE) who might benefit from AD treatment (duration: 20–30 min)

See this image and copyright information in PMC

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How to improve adherence to antidepressant treatments in patients with major depression: a psychoeducational consensus checklist

Affiliations

How to improve adherence to antidepressant treatments in patients with major depression: a psychoeducational consensus checklist

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

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Research Materials